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Get Odjfs Employment Verification Form Cuyahoga County

CUYAHOGA COUNTY EMPLOYEE INCOME RESIDENCY VERIFICATION FORM DEPARTMENT OF DEVELOPMENT SECTION 3 PROGRAM Print Reset Form TO BE COMPLETED BY EMPLOYER Business Name Date Completed Address State City Zip Person Completing This Form Telephone Number Fax Number Email Address I am an employee of the business listed above AND Please answer by placing a check in the appropriate box I am a low-income resident as defined by HUD residing in the covered metropolitan area. My Total Household Income last year was not greater than the amount listed below based on the number of persons in my family. Please check the box that applies Family Size Number in Household 1 Person Income less than 36 300. 00 5 Persons 56 000. 00 41 500. 00 60 150. 00 46 650. 00 51 850. 00 68 450. 00 I am NOT a low-income resident as defined by HUD. By signing below I certify that my personal information provided on this form is true and accurate. I agree to provide any documentation if requested that confirms the accuracy of my Residency Family Size and Total Employee Name printed Signature Date Hired Estate Date The goal of the HUD-Section 3 requirement is to provide self-sufficiency opportunities to residents and businesses of neighborhoods receiving HUD funding for fair housing and community development activities. This certification is subject to all rules and regulations developed by the HUD Fraud Waste and Abuse Office. Please check the box that applies Family Size Number in Household 1 Person Income less than 36 300. 00 5 Persons 56 000. 00 41 500. 00 60 150. 00 46 650. 00 51 850. 00 68 450. 00 I am NOT a low-income resident as defined by HUD. 00 5 Persons 56 000. 00 41 500. 00 60 150. 00 46 650. 00 51 850. 00 68 450. 00 I am NOT a low-income resident as defined by HUD. By signing below I certify that my personal information provided on this form is true and accurate. By signing below I certify that my personal information provided on this form is true and accurate. I agree to provide any documentation if requested that confirms the accuracy of my Residency Family Size and Total Employee Name printed Signature Date Hired Estate Date The goal of the HUD-Section 3 requirement is to provide self-sufficiency opportunities to residents and businesses of neighborhoods receiving HUD funding for fair housing and community development activities. I agree to provide any documentation if requested that confirms the accuracy of my Residency Family Size and Total Employee Name printed Signature Date Hired Estate Date The goal of the HUD-Section 3 requirement is to provide self-sufficiency opportunities to residents and businesses of neighborhoods receiving HUD funding for fair housing and community development activities. This certification is subject to all rules and regulations developed by the HUD Fraud Waste and Abuse Office. Please check the box that applies Family Size Number in Household 1 Person Income less than 36 300. 00 5 Persons 56 000. 00 41 500. 00 60 150. 00 46 650. 00 51 850. 00 68 450. 00 I am NOT a low-income resident as defined by HUD. By signing below I certify that my personal information provided on this form is true and accurate.

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